By: Aaminah Shakur
One of the biggest issues facing the health of Indigenous women is disparity in access to care and lack of cultural competency in care. People of color in the United States have significant disparity issues around both access to care and quality of care. Most studies conducted address this for Black- and Hispanic-identified patients, and may gloss over Indigenous-specific disparities, but we can reasonably assume that racism, lack of cultural awareness and the disparity between private vs. public insurance will impact Indigenous patients in the same way as other people of color.
For Indigenous women, these issues are compounded as primary caregivers for our children. The stress we experience dealing with thoughtless or malicious medical staff is magnified as we have the same experience over and over again while trying to get care for our children. We may have less access or less willingness to seek care for our own needs. Some successful campaigns have been waged to inform women of different cultures of the importance of care for our own health so that we are available for our children. Those campaigns, while important, assume access to quality care is available and that the only barrier is the need to be reminded that it is okay to prioritize our own needs. If only it were that easy.
On an individual level, the best way we can work for quality care is to select our providers intentionally and go to appointments well-prepared. Because of a variety of restrictions, such as transportation, office hours and insurance acceptance, we don’t always have great options in selecting our providers. If we do have the ability to be choosy, we should make the most of it. Ask the doctor how they would address certain issues that reveal their methods of care. Ask for recommendations – and who to steer clear of – from friends and family. Listen to your own instincts about comfort level with office staff at your provider. Do they speak to you respectfully? Do they seem kind and open with your children, or are they annoyed by the presence of kids? When attending appointments, arrive 10 minutes prior to the appointment as a rule and always do your best to cancel appointments with at least 24 hours notice. Most medical offices track these things and you will notice that you are treated worse, or even let go from a practice, for repeated infractions. Always be ready to ask your doctor questions and expect them to answer them. Don’t let them give you a diagnosis and run out the door without explaining what it means!
If you feel that you are being mistreated because of assumptions/stereotypes around being Indigenous, bring specific incidences to the practice manager. Depending on how the practice manager handles your concerns and if you see changes, you will be able to determine if they are working to create an inclusive and culturally competent environment or if it’s time for you to find a different provider. All of this advice is also valid for dealing with specialists and mental health services. It is important to know that if you don’t “gel” with a doctor or therapist, you can request to switch. Sometimes that is a better choice than moving to a completely different office, especially if you are dealing with some of the other barriers mentioned.
Of course, there is so much more work that needs to happen on a systemic level to address these disparities. We should consider our individual efforts to let our providers know of our satisfaction or dissatisfaction with care part of how systemic change begins. If we have the availability, we may also consider getting involved with local health literacy and health access task forces. With the roll out of the ACA, funding opportunities went out to help communities build organizations and programs that look at local solutions to disparity of care. Most community health boards also run mass surveys every two to five years to gauge what issues community members prioritize, and healthcare access is almost always in the top five issues. Even insurance plans, especially the ones working with Medicaid and other low-income programs, are getting involved with such efforts or asking their customers to fill out surveys to let them know what issues they face. Many of those programs and surveys actively seek feedback as they work together to craft community plans for addressing the issues. Because Indigenous people represent such a small percentage of the population, our needs are often overlooked, so when we can get involved in initiatives like these, it helps all of us.
In the next column, we will talk about health disparities around pregnancy and childbirth issues.